TED2017
Raj Panjabi: No one should die because they live too far from a doctor
拉杰什·班扎比: 让医疗跨越距离
Filmed:
Readability: 3.9
1,337,947 views
疾病是普遍的——而医疗不是。医生拉杰什·班扎比有一个大胆的想法——把医疗带给世界上的每一个人，带到每一个角落。借着2017TED大奖的机会，班扎比着手建立社区健康学社，一个全球化的平台。这个平台致力于现代化社区健康工作者的学习过程，并创造工作岗位。
Raj Panjabi - Physician
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
A billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile. Full bio
Double-click the English transcript below to play the video.
00:12
I want to share with you
something my father taught me:
something my father taught me:
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我想与大家分享一些
我父亲告诉我的事情，
我父亲告诉我的事情，
00:17
no condition is permanent.
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世界在改变，
00:21
It's a lesson he shared with me
again and again,
again and again,
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他不断地跟我重复这个道理，
00:24
and I learned it to be true the hard way.
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而我用一种更为困难的方式
真正理解了这个道理。
真正理解了这个道理。
这是我小学四年级的班级，
00:28
Here I am in my fourth-grade class.
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我的学校在蒙罗维亚，利比里亚。
00:31
This is my yearbook picture
taken in my class in school
taken in my class in school
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这是我在学校拍的年册照片
00:35
in Monrovia, Liberia.
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00:37
My parents migrated from India
to West Africa in the 1970s,
to West Africa in the 1970s,
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我的家庭在七十年代从印度移民到西非，
于是我有机会在那里成长。
00:41
and I had the privilege
of growing up there.
of growing up there.
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00:45
I was nine years old,
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那时候我九岁，
喜欢踢足球，
00:46
I loved kicking around a soccer ball,
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00:48
and I was a total math and science geek.
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还痴迷于数学和科学，
00:51
I was living the kind of life
that, really, any child would dream of.
that, really, any child would dream of.
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我过着每一个孩子都会羡慕的生活，
00:57
But no condition is permanent.
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但是世界会改变。
01:00
On Christmas Eve in 1989,
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在1989年的圣诞夜，
利比里亚爆发了内战，
01:03
civil war erupted in Liberia.
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01:07
The war started in the rural countryside,
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战争从农村开始，
在数月内，反抗军就行进到了我的家乡，
01:09
and within months, rebel armies
had marched towards our hometown.
had marched towards our hometown.
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01:12
My school shut down,
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我的学校被关闭，
01:14
and when the rebel armies captured
the only international airport,
the only international airport,
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而当反抗军控制了唯一的国际机场，
人们开始恐慌。
01:17
people started panicking and fleeing.
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01:21
My mom came knocking one morning
and said, "Raj, pack your things --
and said, "Raj, pack your things --
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有天早上，我的母亲来敲我的门，
说：“Raj，收拾好你的行李，
说：“Raj，收拾好你的行李，
我们得走了。”
01:25
we have to go."
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01:26
We were rushed to the center of town,
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我们赶到镇子的中心，
在那我们被分成两条队伍，
01:29
and there on a tarmac,
we were split into two lines.
we were split into two lines.
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01:34
I stood with my family in one line,
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我跟我的家庭站在一条队伍里，
接着就被挤进了
01:37
and we were stuffed into the cargo hatch
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救援机舱。
01:39
of a rescue plane.
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01:41
And there on a bench,
I was sitting with my heart racing.
I was sitting with my heart racing.
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坐在那的椅子上，
我的心扑通扑通地跳着
我的心扑通扑通地跳着
当我向着舱外望去，
01:44
As I looked out the open hatch,
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01:46
I saw hundreds of Liberians
in another line,
in another line,
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我看见几百个利比里亚人
站在另一条队伍里，
站在另一条队伍里，
01:49
children strapped to their backs.
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他们的背上用皮带绑着他们的孩子。
01:52
When they tried to jump in with us,
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当他们试图爬上机舱，
我看见士兵们在阻止他们，
01:55
I watched soldiers restrain them.
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01:58
They were not allowed to flee.
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他们逃不了，
02:01
We were the lucky ones.
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我们是幸运的，
02:03
We lost what we had,
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我们失去了我们所拥有的，
但我们被重新安置在了美国。
02:05
but we resettled in America,
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02:07
and as immigrants, we benefitted
from the community of supporters
from the community of supporters
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而作为移民，我们能从一个
充满了热心群众的社区里，
充满了热心群众的社区里，
获得很多帮助。
02:10
that rallied around us.
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02:13
They took my family into their home,
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他们把我的家庭带到他们的家里
教育我，
02:15
they mentored me.
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02:18
And they helped my dad
start a clothing shop.
start a clothing shop.
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甚至协助的我父亲开了一家服装店。
02:20
I'd visit my father
on weekends as a teenager
on weekends as a teenager
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当我还是个青年，
我会在双休日到店里，
我会在双休日到店里，
帮我父亲买些鞋子和牛仔裤。
02:22
to help him sell sneakers and jeans.
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而每当生意不好做的时候，
02:25
And every time business would get bad,
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02:27
he'd remind me of that mantra:
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他总会提起那句格言，
02:29
no condition is permanent.
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世上没有什么是不变的。
02:32
That mantra and my parents' persistence
and that community of supporters
and that community of supporters
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这句格言和我父母的坚持，
以及社区的帮助者，
以及社区的帮助者，
使我有机会读完我的大学，
02:37
made it possible for me
to go through college
to go through college
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甚至最后进入医学院。
02:39
and eventually to medical school.
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02:42
I'd once had my hopes crushed in a war,
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我的希望曾在战争中被击碎，
02:46
but because of them,
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但因为他们，
我有机会追求我的从医梦想，
02:47
I had a chance to pursue my dream
to become a doctor.
to become a doctor.
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02:51
My condition had changed.
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我的世界改变了。
02:54
It had been 15 years
since I escaped that airfield,
since I escaped that airfield,
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距离那次逃难，已经有15年，
但关于那两条队伍的印象
在我脑中挥之不去。
在我脑中挥之不去。
02:57
but the memory of those two lines
had not escaped my mind.
had not escaped my mind.
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03:00
I was a medical student in my mid-20s,
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作为一个二十多岁的医学生，
03:02
and I wanted to go back
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我想回去看看我能否
为留在那里的人们做些什么。
03:04
to see if I could serve
the people we'd left behind.
the people we'd left behind.
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03:07
But when I got back,
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但当我回到那儿，
我看到的是完全的毁灭。
03:08
what I found was utter destruction.
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这场战争给我们留下的是
仅存的51名医生
仅存的51名医生
03:10
The war had left us with just 51 doctors
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要去服务近四百万的人民，
03:12
to serve a country of four million people.
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这就好比旧金山只有10名医生。
03:15
It would be like the city of San Francisco
having just 10 doctors.
having just 10 doctors.
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03:19
So if you got sick in the city
where those few doctors remain,
where those few doctors remain,
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因此，如果你在那些
有医生的城市里生病了，
有医生的城市里生病了，
你可能还有一丝希望，
03:22
you might stand a chance.
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而一旦你在遥远的雨林社区里生病，
03:23
But if you got sick in the remote,
rural rainforest communities,
rural rainforest communities,
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最近的诊所在几天的路程之外，
03:27
where you could be days
from the nearest clinic --
from the nearest clinic --
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我看到我的病人死于
完全不该致死的病症，
完全不该致死的病症，
03:30
I was seeing my patients die
from conditions no one should die from,
from conditions no one should die from,
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而这全都是因为他们
向我寻求救治来的太晚了，
向我寻求救治来的太晚了，
03:34
all because they were
getting to me too late.
getting to me too late.
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试想，你发现你两岁的孩子
在早晨醒来，并且发烧了，
在早晨醒来，并且发烧了，
03:36
Imagine you have a two-year-old
who wakes up one morning with a fever,
who wakes up one morning with a fever,
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03:39
and you realize she could have malaria,
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于是你意识到她可能感染了疟疾，
03:42
and you know the only way to get her
the medicine she needs
the medicine she needs
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而你所知道唯一为她取得药物的途径，
是把她带到河边
03:45
would be to take her to the riverbed,
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坐上木舟，划到彼岸，
03:46
get in a canoe, paddle to the other side
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再走上两天穿过树林，
03:49
and then walk for up to two days
through the forest
through the forest
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03:51
just to reach the nearest clinic.
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找到最近的诊疗师。
03:54
One billion people live
in the world's most remote communities,
in the world's most remote communities,
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十亿人生活在世界上最偏远的社区里，
无论我们的现代医学技术
做出了多少进步，
做出了多少进步，
03:57
and despite the advances we've made
in modern medicine and technology,
in modern medicine and technology,
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04:00
our innovations are not
reaching the last mile.
reaching the last mile.
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这些进步无法踏遍世界的每个角落。
04:03
These communities have been left behind,
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这些社区被落下了，
只因为人们觉得这些地方
04:05
because they've been thought
too hard to reach
too hard to reach
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太难普及医疗。
04:07
and too difficult to serve.
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04:10
Illness is universal;
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疾病踏遍了世界，
而医疗没有。
04:11
access to care is not.
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04:14
And realizing this lit a fire in my soul.
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这个事实在我的心中燃起了一团火，
04:16
No one should die because they live
too far from a doctor or clinic.
too far from a doctor or clinic.
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人们不该因为生活在偏远地区而死亡。
一切都应当能够被改变，
04:21
No condition should be permanent.
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04:25
And help in this case
didn't come from the outside,
didn't come from the outside,
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在这情况下，援助不来自于外部，
而它应该恰恰来自于
04:28
it actually came from within.
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社区本身。
04:29
It came from the communities themselves.
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04:32
Meet Musu.
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这是穆苏，
远在利比里亚乡村，
04:33
Way out in rural Liberia,
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女孩们往往没有机会完成小学教育，
04:34
where most girls have not had
a chance to finish primary school,
a chance to finish primary school,
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04:39
Musu had been persistent.
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而穆苏坚持学业。
04:42
At the age of 18,
she completed high school,
she completed high school,
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在18岁的时候，她完成了他的高中教育，
然后回到了她的家乡，
04:44
and she came back to her community.
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04:46
She saw that none of the children
were getting treatment
were getting treatment
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她发现没有一个生病的孩子
获得了他们应当获得的治疗，
04:49
for the diseases
they needed treatment for --
they needed treatment for --
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04:51
deadly diseases, like malaria
and pneumonia.
and pneumonia.
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而这些这些疾病往往
是致死的，像疟疾、肺炎，
是致死的，像疟疾、肺炎，
04:53
So she signed up to be a volunteer.
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于是，她报名去做志愿者。
04:57
There are millions of volunteers like Musu
in rural parts around our world,
in rural parts around our world,
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世界上有上百万个
像穆苏一样的志愿者，
像穆苏一样的志愿者，
很自然地，我们会想，
05:01
and we got to thinking --
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这些像穆苏一样的社区成员
能够帮助我们解决这个问题。
能够帮助我们解决这个问题。
05:03
community members like Musu
could actually help us solve a puzzle.
could actually help us solve a puzzle.
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05:08
Our health care system
is structured in such a way
is structured in such a way
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我们的医疗系统被一种框架限制着
在这框架中，诊断病症，
开出处方等工作，
开出处方等工作，
05:10
that the work of diagnosing disease
and prescribing medicines
and prescribing medicines
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只能由医生或护士团队来完成，
05:14
is limited to a team of nurses
and doctors like me.
and doctors like me.
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05:18
But nurses and doctors
are concentrated in cities,
are concentrated in cities,
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但医生和护士集中在城市中，
因此像穆苏的社区就被拉下了。
05:21
so rural communities like Musu's
have been left behind.
have been left behind.
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05:24
So we started asking some questions:
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于是，我们开始发问，
如果我们能重塑这个系统，
05:26
What if we could reorganize
the medical care system?
the medical care system?
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如果我们能让像穆苏一样的社区成员
05:29
What if we could have community
members like Musu
members like Musu
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05:32
be a part or even be the center
of our medical team?
of our medical team?
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成为医疗队伍的一员甚至是核心，
05:35
What if Musu could help us bring
health care from clinics in cities
health care from clinics in cities
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如果穆苏能帮我们
把医疗从城市的诊所
把医疗从城市的诊所
移到她邻居的门前？
05:39
to the doorsteps of her neighbors?
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05:43
Musu was 48 when I met her.
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在我遇到她时，
穆苏48岁了，
穆苏48岁了，
05:46
And despite her amazing talent and grit,
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尽管她很有天赋，也很坚韧，
她却有近三十年
不曾从事过带薪的工作。
不曾从事过带薪的工作。
05:49
she hadn't had a paying job in 30 years.
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05:53
So what if technology could support her?
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如果我们能够用科技来帮助她，
05:56
What if we could invest in her
with real training,
with real training,
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如果我们能以实际的训练来投资她，
以实际的药物来武装她，
06:00
equip her with real medicines,
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06:03
and have her have a real job?
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让她，有个真正的工作？
06:08
Well, in 2007, I was trying
to answer these questions,
to answer these questions,
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在2007年，我尝试回答这些问题，
我的妻子与我也在那年结婚了，
06:12
and my wife and I were
getting married that year.
getting married that year.
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06:16
We asked our relatives to forgo
the wedding registry gifts
the wedding registry gifts
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我们没让我们的亲戚
给我们结婚礼物，
给我们结婚礼物，
反而， 我们让他们捐些钱
06:20
and instead donate some money
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给我们来启动我们的非盈利公益活动。
06:22
so we could have some start-up money
to launch a nonprofit.
to launch a nonprofit.
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06:26
I promise you, I'm a lot
more romantic than that.
more romantic than that.
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相信我，我本人比这要浪漫多了。
（笑声）
06:28
(Laughter)
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06:30
We ended up raising $6,000,
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我们最后募得了6000美金，
找到了一些利比里亚和美国队员，
06:32
teamed up with some
Liberians and Americans
Liberians and Americans
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06:34
and launched a nonprofit
called Last Mile Health.
called Last Mile Health.
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启动了这个非盈利组织
叫做“最后一英里健康”。
叫做“最后一英里健康”。
06:37
Our goal is to bring a health worker
within reach of everyone, everywhere.
within reach of everyone, everywhere.
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我们的目标是给世界上
每一个人带去一个医疗工作者，
每一个人带去一个医疗工作者，
我们设计了一个三步走计划：
06:42
We designed a three-step process --
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训练，武装，支付。
06:44
train, equip and pay --
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06:45
to invest more deeply
in volunteers like Musu
in volunteers like Musu
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为了投资更多像穆苏一样的志愿者
成为辅助性专业人员，
06:49
to become paraprofessionals,
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06:50
to become community health workers.
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成为社区保健工作者，
06:53
First we trained Musu to prevent,
diagnose and treat
diagnose and treat
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首先我们训练穆苏
去防护，诊断，治疗，
去防护，诊断，治疗，
十种她村庄里最为猖獗的疾病，
06:57
the top 10 diseases afflicting
families in her village.
families in her village.
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07:01
A nurse supervisor visited her
every month to coach her.
every month to coach her.
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一个护士监察者每月
探访她并训练她，
探访她并训练她，
07:05
We equipped her with modern
medical technology,
medical technology,
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我们用现代医疗技术去武装她，
像是这个一美元疟疾速诊。
07:08
like this $1 malaria rapid test,
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07:11
and put it in a backpack
full of medicines like this
full of medicines like this
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我们把这些放在一个
满是类似药品的背包里，
满是类似药品的背包里，
来治疗包括肺炎的感染。
07:15
to treat infections like pneumonia,
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07:18
and crucially,
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最关键的
我们还提供了一个智能手机，
让穆苏能跟踪和汇报流行病的情况，
让穆苏能跟踪和汇报流行病的情况，
07:20
a smartphone, to help her track
and report on epidemics.
and report on epidemics.
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07:25
Last, we recognized
the dignity in Musu's work.
the dignity in Musu's work.
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最后，我们认识到了
穆苏工作的严肃性。
穆苏工作的严肃性。
在与政府的合作下，
我们与穆苏建立了合同
我们与穆苏建立了合同
07:28
With the Liberian government,
we created a contract,
we created a contract,
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07:30
paid her
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支付她薪水，
07:32
and gave her the chance
to have a real job.
to have a real job.
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并且给她一个真正的工作，
而她真是特别棒！
07:34
And she's amazing.
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07:35
Musu has learned over 30 medical skills,
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她习得了超过30种医疗技能，
07:39
from screening children for malnutrition,
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从筛查营养不良的孩子
到用手机来评估孩子咳嗽的原因，
07:41
to assessing the cause
of a child's cough with a smartphone,
of a child's cough with a smartphone,
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07:45
to supporting people with HIV
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再到帮助人们对抗艾滋病
以及提供失去四肢的病人后续帮助。
07:48
and providing follow-up care
to patients who've lost their limbs.
to patients who've lost their limbs.
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07:53
Working as part of our team,
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作为我们团队的一员，
作为辅助性医疗人员，
07:56
working as paraprofessionals,
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社区健康工作者能够帮助做到
07:57
community health workers can help ensure
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07:59
that a lot of what
your family doctor would do
your family doctor would do
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很多你的家庭医生能做的
而去到那些你的家庭医生去不了的地方。
08:02
reaches the places that most
family doctors could never go.
family doctors could never go.
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08:06
One of my favorite things to do
is to care for patients
is to care for patients
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我最爱的事情之一，
就是和社区健康工作者一起，
就是和社区健康工作者一起，
诊疗病人。
08:09
with community health workers.
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08:10
So last year I was visiting A.B.,
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因此，去年我去拜访A.B.，
08:12
and like Musu, A.B. had had
a chance to go to school.
a chance to go to school.
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像穆苏一样，A.B.曾有机会读书，
08:16
He was in middle school,
in the eighth grade,
in the eighth grade,
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那时，他在中学，
就读于八年级，
就读于八年级，
08:19
when his parents died.
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他的父母死了，
他成了一个孤儿，只能辍学。
08:20
He became an orphan and had to drop out.
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08:24
Last year, we hired and trained
A.B. as a community health worker.
A.B. as a community health worker.
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去年我们雇佣了他，
并将他训练成了一个社区健康工作者，
并将他训练成了一个社区健康工作者，
08:30
And while he was making
door to door house calls,
door to door house calls,
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当他在一户一户地进行检查时，
08:33
he met this young boy named Prince,
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他遇到了这个男孩，他叫普林斯，
他的母亲不能用母乳喂养他，
08:35
whose mother had had trouble
breastfeeding him,
breastfeeding him,
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08:38
and by the age of six months,
Prince had started to waste away.
Prince had started to waste away.
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到了他六个月大的时候，
他开始消瘦，
他开始消瘦，
08:41
A.B. had just been taught how to use
this color-coded measuring tape
this color-coded measuring tape
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A.B.刚刚被教授了
怎么用这个彩色码测量带。
怎么用这个彩色码测量带。
环绕在孩子的上臂上来诊断营养不良，
08:45
that wraps around the upper arm
of a child to diagnose malnutrition.
of a child to diagnose malnutrition.
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他意识到普林斯在红区了，
08:49
A.B. noticed that Prince
was in the red zone,
was in the red zone,
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08:51
which meant he had to be hospitalized.
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这意味着普林斯必须得被送到医院，
08:53
So A.B. took Prince
and his mother to the river,
and his mother to the river,
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于是A.B.把普林斯和他妈妈送到河边，
坐上木舟，
08:56
got in a canoe
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划船四小时抵达医院。
08:57
and paddled for four hours
to get to the hospital.
to get to the hospital.
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08:59
Later, after Prince was discharged,
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后来，普林斯从医院回家后，
09:02
A.B. taught mom how to feed baby
a food supplement.
a food supplement.
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A.B.教会了这个母亲
怎么喂养这个孩子。
怎么喂养这个孩子。
09:07
A few months ago,
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几个月之前，
A.B.带我去见了普林斯，
他是个肉墩墩的孩子，
他是个肉墩墩的孩子，
09:09
A.B. took me to visit Prince,
and he's a chubby little guy.
and he's a chubby little guy.
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09:13
(Laughter)
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（笑声）
09:14
He's meeting his milestones,
he's pulled himself up to a stand,
he's pulled himself up to a stand,
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他刚刚经过了他生命的里程碑，
他开始走路了，
他开始走路了，
甚至开始说话。
09:17
and is even starting to say a few words.
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09:19
I'm so inspired by these
community health workers.
community health workers.
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我被这些社区健康工作者
深深地激发了，
深深地激发了，
09:22
I often ask them why they do what they do,
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我常问他们为什么他们要这么做？
当我问到A.B.，
09:24
and when I asked A.B.,
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09:26
he said, "Doc, since I dropped out
of school, this is the first time
of school, this is the first time
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他说：“医生，从我辍学起
这是我第一次有机会用笔写字，
09:30
I'm having a chance
to hold a pen to write.
to hold a pen to write.
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09:34
My brain is getting fresh."
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我的大脑像是获得了新生。”
09:38
The stories of A.B. and Musu
have taught me something fundamental
have taught me something fundamental
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A.B.和穆苏的故事教给我，
我们作为一个人类
所拥有的最根本的东西，
所拥有的最根本的东西，
09:41
about being human.
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09:44
Our will to serve others
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我们愿意帮助他人的意愿
09:47
can actually help us
transform our own conditions.
transform our own conditions.
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能够真切地帮助我们改变自己的世界。
09:51
I was so moved by how powerful
the will to serve our neighbors can be
the will to serve our neighbors can be
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在几年前，
我深深地被这种强大的意愿感动了。
09:55
a few years ago,
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09:58
when we faced a global catastrophe.
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在2013年的十二月，
那时我们正在面对全球性灾难，
10:00
In December 2013,
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一件事情在几内亚的雨林里发生了。
10:02
something happened in the rainforests
across the border from us in Guinea.
across the border from us in Guinea.
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一个叫艾米尔的孩子感到
不适并伴随着呕吐发烧和腹泻，
不适并伴随着呕吐发烧和腹泻，
10:05
A toddler named Emile fell sick
with vomiting, fever and diarrhea.
with vomiting, fever and diarrhea.
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10:10
He lived in an area
where the roads were sparse
where the roads were sparse
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他住在道路稀疏的地方，
而那里极度稀缺健康工作者。
10:12
and there had been massive
shortages of health workers.
shortages of health workers.
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10:16
Emile died,
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艾米尔死了，
又过了几周，他的姐姐死了，
10:18
and a few weeks later his sister died,
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10:19
and a few weeks later his mother died.
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又是几周，他的母亲也死了，
10:21
And this disease would spread
from one community to another.
from one community to another.
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这种疾病从一个村庄
扩散到另一个村庄。
扩散到另一个村庄。
直到三个月后，
10:25
And it wasn't until three months later
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世人才意识到这就是埃博拉，
10:27
that the world recognized this as Ebola.
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10:30
When every minute counted,
we had already lost months,
we had already lost months,
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在这需要争分夺秒的情况下
我们已经失去了几个月的时间，
我们已经失去了几个月的时间，
那时，病毒已经
像野火一样肆虐了整个西非，
像野火一样肆虐了整个西非，
10:33
and by then the virus had spread
like wildfire all across West Africa,
like wildfire all across West Africa,
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3453
10:36
and eventually to other
parts of the world.
parts of the world.
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而最终到达世界上的其他地方。
10:38
Businesses shut down,
airlines started canceling routes.
airlines started canceling routes.
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商业停滞，航线被取消，
10:41
At the height of the crisis,
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在这场灾难的顶点，
我们被告知有
一百四十万人感染了这种病毒，
一百四十万人感染了这种病毒，
10:43
when we were told that 1.4 million
people could be infected,
people could be infected,
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4445
10:47
when we were told
that most of them would die,
that most of them would die,
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3503
而他们中的大多数都将死亡。
我们几乎丧失了所有希望。
10:51
when we had nearly lost all hope,
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10:55
I remember standing with a group
of health workers
of health workers
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我记得那时我和
一群健康工作者站在一起，
一群健康工作者站在一起，
在雨林中，一场病毒刚刚爆发，
10:58
in the rainforest where
an outbreak had just happened.
an outbreak had just happened.
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我们教会他们戴上面具，
11:01
We were helping train and equip
them to put on the masks,
them to put on the masks,
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11:04
the gloves and the gowns that they needed
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手套，防护衣
来抵御病毒。
11:06
to keep themselves safe from the virus
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1995
当他们帮助他们的病患时，
11:08
while they were serving their patients.
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2308
11:10
I remember the fear in their eyes.
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我看到了他们眼中的恐惧，
11:14
And I remember staying up at night,
terrified if I'd made the right call
terrified if I'd made the right call
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我也记得彻夜不眠，怀疑自己选择，
11:20
to keep them in the field.
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让他们继续在前线工作是否是正确的。
11:22
When Ebola threatened to bring
humanity to its knees,
humanity to its knees,
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当埃博拉的阴影开始摧毁人心，
利比里亚的社区工作者没有向恐惧屈服，
11:27
Liberia's community health workers
didn't surrender to fear.
didn't surrender to fear.
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3073
11:31
They did what they had always done:
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他们坚持他们一贯的做法，
继续回应邻里的医疗请求。
11:34
they answered the call
to serve their neighbors.
to serve their neighbors.
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11:37
Community members across Liberia
learned the symptoms of Ebola,
learned the symptoms of Ebola,
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全利比里亚的社区成员都
习得了如何分辨埃博拉的症状。
习得了如何分辨埃博拉的症状。
他们联合起医生和护士
挨家挨户地寻找患病的人，
挨家挨户地寻找患病的人，
11:41
teamed up with nurses and doctors
to go door-to-door to find the sick
to go door-to-door to find the sick
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11:44
and get them into care.
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让他们获得医治，
11:46
They tracked thousands of people
who had been exposed to the virus
who had been exposed to the virus
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3410
他们追踪上千个接触过病毒的人，
来截断病毒的传染链，
11:49
and helped break
the chain of transmission.
the chain of transmission.
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万余名社区健康工作者以身犯险，
11:52
Some ten thousand community
health workers risked their own lives
health workers risked their own lives
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11:55
to help hunt down this virus
and stop it in its tracks.
and stop it in its tracks.
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追踪并消灭病毒源。
11:59
(Applause)
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5885
（掌声）
12:06
Today, Ebola has come
under control in West Africa,
under control in West Africa,
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今天在西非，
埃博拉已经被控制住了，
埃博拉已经被控制住了，
我们也学到了一些事情，
12:10
and we've learned a few things.
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1621
12:12
We've learned that blind spots
in rural health care
in rural health care
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我们发现了乡村医疗的盲区，
12:14
can lead to hot spots of disease,
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1798
会变成疾病滋生的热区，
而这会让我们所有人处于更危险的境地，
12:16
and that places all of us at greater risk.
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724793
2416
12:19
We've learned that the most efficient
emergency system
emergency system
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2692
我们学到了，最有效的应急系统
正是日常系统。
12:22
is actually an everyday system,
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2028
12:24
and that system has to reach
all communities,
all communities,
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2726
这样的系统必须延伸到所有的社区，
12:27
including rural communities like Emile's.
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包括像艾米尔所在的社区
12:30
And most of all,
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1151
而最重要的，
我们从利比里亚社区工作者的勇气中
12:31
we've learned from the courage
of Liberia's community health workers
of Liberia's community health workers
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认识到了人们不会被
他们遇到的环境所定义的。
他们遇到的环境所定义的。
12:35
that we as people are not defined
by the conditions we face,
by the conditions we face,
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3721
12:38
no matter how hopeless they seem.
254
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2064
无论环境多么的无助，
12:42
We're defined by how we respond to them.
255
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2132
我们被我们的处理问题的方式所定义。
12:46
For the past 15 years,
256
754300
2051
在过去的十五年中，
12:49
I've seen the power of this idea
257
757249
2003
我多次印证，这种想法的力量，
能够把普通市民，
变成社区健康工作者
变成社区健康工作者
12:51
to transform everyday citizens
into community health workers --
into community health workers --
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759276
4097
12:55
into everyday heroes.
259
763397
1863
变成——英雄。
12:58
And I've seen it play out everywhere,
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1802
我也同样在别处看到它发挥作用，
从西非的雨林社区
12:59
from the forest communities
of West Africa,
of West Africa,
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2058
到阿拉斯加的乡村渔村，
13:02
to the rural fishing villages of Alaska.
262
770032
2245
13:04
It's true,
263
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1150
这是真的。
这些社区健康工作者
是没法作神经手术，
是没法作神经手术，
13:06
these community health workers
aren't doing neurosurgery,
aren't doing neurosurgery,
264
774153
3049
13:09
but they're making it possible
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1492
但他们在使
13:10
to bring health care within reach
of everyone everywhere.
of everyone everywhere.
266
778742
3072
把医疗带给每个人，
变成可能。
变成可能。
13:15
So now what?
267
783645
1217
所以，现在呢？
13:17
Well, we know that there are still
millions of people dying
millions of people dying
268
785812
3764
我们清楚地认识到，
仍然有上百万生活在乡村里的人
13:21
from preventable causes
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789600
1749
13:23
in rural communities around the world.
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1875
死于可预防的疾病。
13:25
And we know that the great majority
of these deaths are happening
of these deaths are happening
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3841
我们也知道，大部分这些死亡
在这七十五个蓝色区域里发生，
13:29
in these 75 blue-shaded countries.
272
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2323
13:31
What we also know
273
799849
1151
但我们知道，
如果我们训练一支
由社区健康工作者组成的队伍，
由社区健康工作者组成的队伍，
13:33
is that if we trained an army
of community health workers
of community health workers
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801024
3443
教会他们30种救命的技能，
13:36
to learn even just 30 lifesaving skills,
275
804491
3333
13:40
we could save the lives of nearly
30 million people by 2030.
30 million people by 2030.
276
808508
4116
到2030年，我们能够救活三千万人。
13:45
Thirty services could save
30 million lives by 2030.
30 million lives by 2030.
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813652
4645
三十种服务，就能救三千万。
这不是纸上谈兵，
13:50
That's not just a blueprint --
278
818321
1743
13:52
we're proving this can be done.
279
820088
1795
我们已经证明这是可行的，
13:53
In Liberia,
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821907
1160
在利比里亚，
政府已经在训练
上千名像A.B.和穆苏一样的工作者。
上千名像A.B.和穆苏一样的工作者。
13:55
the Liberian government is training
thousands of workers like A.B. and Musu
thousands of workers like A.B. and Musu
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4265
13:59
after Ebola,
282
827380
1158
在埃博拉之后，
把医疗带给每个孩子和家庭，
14:00
to bring health care to every
child and family in the country.
child and family in the country.
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828562
3477
能与他们工作，我们感到很荣幸。
14:04
And we've been honored to work with them,
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2031
14:06
and are now teaming up
with a number of organizations
with a number of organizations
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2508
现在，我们也联合了
数个跨国公益组织
14:08
that are working across other countries
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来让他们进行相同的操作。
14:10
to try to help them do the same thing.
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14:14
If we could help these countries scale,
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如果我们能够帮助这些国家，
14:17
we could save millions of lives,
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我们能够救活百万条性命。
14:19
and at the same time,
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847206
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同时，
14:20
we could create millions of jobs.
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我们能够提供百万个工作
14:23
We simply can't do that, though,
without technology.
without technology.
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2922
而科技是这一切的支撑，
14:27
People are worried that technology
is going to steal our jobs,
is going to steal our jobs,
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855286
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人们担心科技会夺走人们的工作。
但在这个领域
14:30
but when it comes
to community health workers,
to community health workers,
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858398
2199
14:32
technology has actually
been vital for creating jobs.
been vital for creating jobs.
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860621
3256
科技是创造就业的核心，
没有科技——没有智能手机，
14:35
Without technology --
without this smartphone,
without this smartphone,
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——没有快速测试，
14:38
without this rapid test --
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866341
2722
14:41
it would have been impossible for us
to be able to employ A.B. and Musu.
to be able to employ A.B. and Musu.
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4533
我们不可能雇佣A.B.和穆苏。
14:47
And I think it's time
for technology to help us train,
for technology to help us train,
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2682
我想是时候让科技来帮助我们训练，
帮助我们更快更好地训练人们
14:50
to help us train people faster
and better than ever before.
and better than ever before.
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3540
14:54
As a doctor,
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1150
作为一个医生，
我通过科技来
更新自己的技术，并获得认证，
更新自己的技术，并获得认证，
14:55
I use technology to stay up-to-date
and keep certified.
and keep certified.
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3491
14:59
I use smartphones, I use apps,
I use online courses.
I use online courses.
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2695
我使用手机，使用软件，
使用网上课程，
使用网上课程，
15:01
But when A.B. wants to learn,
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2212
但当A.B.想要学习时，
他必须得坐那艘独木舟，
15:04
he's got to jump back in that canoe
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892222
2095
15:07
and get to the training center.
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895152
1640
来到那个训练中心。
当穆苏来参加训练，
15:08
And when Musu shows up for training,
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896816
2192
15:11
her instructors are stuck using
flip charts and markers.
flip charts and markers.
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899710
3605
她的指导还只能用翻板和马克笔
来讲课，
来讲课，
15:16
Why shouldn't they have the same
access to learn as I do?
access to learn as I do?
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904147
4533
为什么他们不能像我们一样
可以容易得学到知识呢？
可以容易得学到知识呢？
15:22
If we truly want community health workers
to master those lifesaving skills
to master those lifesaving skills
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910384
3628
如果我们真的想让社区健康工作者
掌握那些救命的技术，
掌握那些救命的技术，
甚至更多,
15:26
and even more,
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914036
1252
15:28
we've got to change this old-school
model of education.
model of education.
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916098
3254
我们得改变这种老掉牙的教育模式，
15:32
Tech can truly be a game changer here.
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920282
1898
科技将成为一个转折点，
我一直以来都被由可汗学院和edX引起的
15:34
I've been in awe of the digital
education revolution
education revolution
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922204
3545
数字化教育革命所震撼。
15:37
that the likes of Khan Academy
and edX have been leading.
and edX have been leading.
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925773
3160
15:42
And I've been thinking that it's time;
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930041
2493
我想也是时候了，
是时候来一场数字化教育革命
15:44
it's time for a collision
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932558
1391
和社区健康革命
15:45
between the digital education revolution
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933973
2311
的碰撞了。
15:48
and the community health revolution.
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936308
2150
15:51
And so, this brings me
to my TED Prize wish.
to my TED Prize wish.
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939483
3220
因此，我要在此处说出我的TED大奖愿望：
15:55
I wish --
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943759
1801
我希望，
我希望你们可以帮助我们招募
15:57
I wish that you would help us recruit
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945584
2206
最大的社区健康工作者军队，
15:59
the largest army of community health
workers the world has ever known
workers the world has ever known
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947814
3928
16:04
by creating the Community Health Academy,
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952068
2825
通过成立社区健康学社，
建立一个全球化的平台，
来训练，联合和使人们更有能力。
来训练，联合和使人们更有能力。
16:06
a global platform to train,
connect and empower.
connect and empower.
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954917
3205
16:10
(Applause)
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958797
1166
（掌声）
16:11
Thank you.
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959988
1162
谢谢。
16:13
(Applause)
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961175
3602
（掌声）
16:16
Thank you.
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964801
1158
谢谢
16:19
Here's the idea:
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967816
1544
这是具体的想法：
我们会发展并管理，
16:21
we'll create and curate
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969384
2070
16:24
the best in digital education resources.
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972066
3875
最佳的数字教育资源，
16:28
We will bring those to community
health workers around the world,
health workers around the world,
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976802
4635
我们会把这些资源带到
全世界社区健康工作者的手里，
全世界社区健康工作者的手里，
包括A.B.和穆苏，
16:33
including A.B. and Musu.
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981461
1253
他们会看到关于给孩子
注射疫苗的视频课程，
注射疫苗的视频课程，
16:34
They'll get video lessons
on giving kids vaccines
on giving kids vaccines
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982738
2802
16:37
and have online courses
on spotting the next outbreak,
on spotting the next outbreak,
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985564
3213
以及获取线上关于
发现下一个热点的课程，
发现下一个热点的课程，
因而他们将不会再
因为只能用翻板，而不能好好上课，
因为只能用翻板，而不能好好上课，
16:40
so they're not stuck using flip charts.
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988801
1883
我们会帮助这些国家鉴定这些工作者，
16:42
We'll help these countries
accredit these workers,
accredit these workers,
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990708
3836
16:46
so that they're not stuck remaining
an under-recognized, undervalued group,
an under-recognized, undervalued group,
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994568
4707
让他们不再被低估和轻视，
而是受到尊敬和授权，
16:51
but become a renowned,
empowered profession,
empowered profession,
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999299
2737
16:54
just like nurses and doctors.
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1002060
1761
就像医生和护士一样，
16:57
And we'll create a network
of companies and entrepreneurs
of companies and entrepreneurs
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1005406
3323
我们还会建立一个企业与公司的网络，
这些机构都发明了可以救命的产品，
17:00
who've created innovations
that can save lives
that can save lives
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1008753
2276
17:03
and help them connect
to workers like Musu,
to workers like Musu,
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1011053
2380
网络把穆苏和这些机构联合在一起，
17:05
so she can help better
serve her community.
serve her community.
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1013457
2575
让像穆苏一样的工作者
能够更好地服务社区，
能够更好地服务社区，
17:08
And we'll work tirelessly
to persuade governments
to persuade governments
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1016959
3206
我们会不知疲倦地说服政府，
把社区健康工作者
作为他们医疗计划的基石，
作为他们医疗计划的基石，
17:12
to make community health workers
a cornerstone of their health care plans.
a cornerstone of their health care plans.
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1020189
3982
17:17
We plan to test and prototype
the academy in Liberia
the academy in Liberia
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1025734
3789
我们正计划在利比里亚
和其他几个合作国家
和其他几个合作国家
17:21
and a few other partner countries,
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1029547
1872
测试并初步架构这种机构，
17:23
and then we plan to take it global,
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1031443
1787
也计划着将它推向全球化，
包括北美的乡村。
17:25
including to rural North America.
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1033254
2223
17:28
With the power of this platform,
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1036103
1590
有着这个平台的支持，
我们认为这些国家会更容易相信，
17:29
we believe countries can be more persuaded
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1037717
2562
医疗革命是可能的。
17:32
that a health care revolution
really is possible.
really is possible.
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1040303
3325
17:36
My dream is that this academy
will contribute to the training
will contribute to the training
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1044470
4088
我的梦想这个机构能够
训练千百个社区成员
17:40
of hundreds of thousands
of community members
of community members
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1048582
2212
来把医疗带给他们的邻居。
17:42
to help bring health care
to their neighbors --
to their neighbors --
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1050818
2899
17:45
the hundreds of millions of them
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1053741
1610
上亿居住在世界最偏远角落
的邻居，
17:47
that live in the world's most
remote communities,
remote communities,
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1055375
2621
17:50
from the forest communities
of West Africa,
of West Africa,
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1058785
2081
从西非的雨林社区
到阿拉斯加的乡野渔村，
17:52
to the fishing villages of rural Alaska;
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1060890
2140
从阿巴拉契亚山顶到阿富汗的山上，
17:55
from the hilltops of Appalachia,
to the mountains of Afghanistan.
to the mountains of Afghanistan.
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1063054
4062
17:59
If this vision is aligned with yours,
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1067140
2690
如果你也希望这个设想成真，
进入 communityhealthacademy.org
18:01
head to communityhealthacademy.org,
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1069854
3221
18:05
and join this revolution.
365
1073740
1680
加入这场改革。
18:08
Let us know if you or your organization
or someone you know could help us
or someone you know could help us
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1076536
4653
在我们决定明年开始建立这个机构的时候，
让我们知道你和你的组织或者你认识的人
是否愿意帮助我们，
是否愿意帮助我们，
18:13
as we try to build this academy
over the next year.
over the next year.
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1081213
3231
18:17
Now, as I look out into this room,
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1085574
1956
现在，正如我环视这个大厅，
18:20
I realize that our journeys
are not self-made;
are not self-made;
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1088310
2706
我意识到我们的路程并不是孤立的，
它是也由别人铸造的。
18:23
they're shaped by others.
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1091040
1509
有太多的东西让我们发起这个活动，
18:24
And there have been so many here
that have been part of this cause.
that have been part of this cause.
371
1092573
3843
18:28
We're so honored to be part
of this community,
of this community,
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1096440
3210
我们非常荣幸能成为这个社区的一员，
18:31
and a community that's willing
to take on a cause
to take on a cause
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1099674
2683
这个敢于启动，
这个项目的社区。
18:34
as audacious as this one,
374
1102381
1368
因此，在最后，我想提出
18:35
so I wanted to offer, as I end,
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1103773
2075
一些反馈，
18:37
a reflection.
376
1105872
1222
18:39
I think a lot more about
what my father taught me.
what my father taught me.
377
1107986
2987
我更多地想到我父亲教会我的事，
18:43
These days, I too have become a dad.
378
1111726
2201
近来，我也成为了一个父亲，
我有两个儿子。
18:45
I have two sons,
379
1113951
2016
18:47
and my wife and I just learned
that she's pregnant with our third child.
that she's pregnant with our third child.
380
1115991
3988
我的妻子和我也刚刚
知道她怀上了第三个孩子，
知道她怀上了第三个孩子，
18:52
(Applause)
381
1120003
1008
（掌声）
18:53
Thank you.
382
1121035
1067
谢谢
18:54
(Applause)
383
1122126
1551
（掌声）
18:56
I was recently caring
for a woman in Liberia
for a woman in Liberia
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1124056
2828
我最经在为一个
利比里亚的女人提供帮助，
利比里亚的女人提供帮助，
她，像我的妻子一样，
在她的第三次妊娠期,
在她的第三次妊娠期,
18:58
who, like my wife,
was in her third pregnancy.
was in her third pregnancy.
385
1126908
2725
19:02
But unlike my wife,
386
1130371
1709
但不像我的妻子,
19:04
had had no prenatal care
with her first two babies.
with her first two babies.
387
1132958
2999
她从没有产前护理过她的前两个孩子，
19:09
She lived in an isolated community
in the forest that had gone for 100 years
in the forest that had gone for 100 years
388
1137549
4392
她生活在一个与世隔绝的雨林社区，
19:13
without any health care
389
1141965
1389
那儿，已经有一百年没有医疗了。
19:16
until ...
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1144513
1628
直到
直到去年，一个护士训练了她的邻居
19:18
until last year when a nurse
trained her neighbors
trained her neighbors
391
1146165
3383
成为一个社区健康工作者。
19:21
to become community health workers.
392
1149572
1711
19:23
So here I was,
393
1151307
1292
所以我在那
诊疗这个在她的妊娠中期的病人，
19:24
seeing this patient
who was in her second trimester,
who was in her second trimester,
394
1152623
4240
一边用超声波检查胎儿，
19:28
and I pulled out the ultrasound
to check on the baby,
to check on the baby,
395
1156887
3272
19:32
and she started telling us stories
about her first two kids,
about her first two kids,
396
1160183
3539
一边听她说她前两个孩子的故事，
我的超声探头在她的腹部，
19:35
and I had the ultrasound
probe on her belly,
probe on her belly,
397
1163746
3198
她说到一半突然停住了。
19:38
and she just stopped mid-sentence.
398
1166968
2268
19:43
She turned to me and she said,
399
1171221
1541
她转向我说，
“医生，这是什么声音？”
19:44
"Doc, what's that sound?"
400
1172786
2294
19:49
It was the first time she'd ever heard
her baby's heartbeat.
her baby's heartbeat.
401
1177371
3178
这是第一次她听到她孩子的心跳，
19:54
And her eyes lit up in the same way
my wife's eyes and my own eyes lit up
my wife's eyes and my own eyes lit up
402
1182111
5060
她的眼睛发亮，
就像我和我妻子听到
我们孩子的心跳时那样发亮。
我们孩子的心跳时那样发亮。
19:59
when we heard our baby's heartbeat.
403
1187195
2135
20:03
For all of human history,
404
1191544
2153
在人类历史上，
疾病是普遍的，而医疗不是。
20:05
illness has been universal
and access to care has not.
and access to care has not.
405
1193721
4532
但就像一个智者曾告诉我的，
20:10
But as a wise man once told me:
406
1198277
1886
20:13
no condition is permanent.
407
1201690
2488
世上没有什么是不变的。
20:17
It's time.
408
1205491
1228
是时候了，
是时候让我们用尽全力，
20:18
It's time for us to go as far as it takes
409
1206743
2323
一起来改变现状。
20:21
to change this condition together.
410
1209090
2092
20:23
Thank you.
411
1211694
1154
谢谢。
20:24
(Applause)
412
1212872
4467
（掌声）
ABOUT THE SPEAKER
Raj Panjabi - PhysicianA billion people around the world lack access to health care because they live too far from a clinic. 2017 TED Prize winner Raj Panjabi aims to extend health services to the last mile.
Why you should listen
Raj Panjabi was nine when civil war broke out in his native country, Liberia. His family resettled in High Point, North Carolina, but he returned to Liberia as a medical student in 2005. He was shocked to find a health care system in total devastation. Only 50 doctors remained to treat a population of four million.
With a team of Liberian civil war survivors, American health workers and $6,000 he'd received as a wedding gift, Panjabi co-founded Last Mile Health. The organization saves lives in the world's most remote communities by partnering with governments to deploy, sustain and manage national networks of community health professionals. They currently support the Government of Liberia's deployment of more than 4,000 health workers to provide life-saving healthcare to 1.2 million people and protect against the next epidemic. Last Mile Health's network of community health workers can be leveraged in a crisis -- in the fight against Ebola, the organization aided government response by training health workers in southeastern Liberia.
Panjabi is a physician in the Division of Global Health Equity at Harvard Medical School, Brigham and Women's Hospital. He is a recipient of the Skoll Award for Social Entrepreneurship and was named to TIME's list of the "100 Most Influential People in the World" in 2016. As the winner of the 2017 TED Prize, Panjabi is creating the Community Health Academy, a global platform to train, connect and empower community health workers. The Academy aims to reinvent the education of community health workers -- and the leaders who support them -- for the digital age.
Raj Panjabi | Speaker | TED.com